Direct-Acting Oral Anticoagulants: Practical Considerations for Emergency Medicine Physicians
Table 4
DOAC dosing for treatment and secondary prevention of VTE in the US [13–16].
Patient population
Dabigatran
Rivaroxaban
Apixaban
Edoxaban
General population
150 mg twice daily after 5–10 days of initial parenteral therapy if CrCl >30 mL/min
15 mg twice daily for 21 days and then 20 mg once daily
10 mg twice daily for 7 days and then 5 mg twice daily
60 mg once daily following 5–10 days of initial parenteral anticoagulant therapy
Renal impairment
No recommendations if CrCl ≤30 mL/min or on dialysis
Avoid if CrCl <30 mL/min
No dose change
Reduce dose to 30 mg once daily if CrCl is 15–50 mL/min
Elderly
No dose change
No dose change
No dose change
No dose change
Low body weight
NR
No dose change
NR
Reduce dose to 30 mg once daily if weight ≤60 kg
Concomitant P-gp inhibitor
Avoid if CrCl <50 mL/min
Avoid if P-gp inhibitor is also a strong CYP3A4 inhibitor
Reduce to 5.0 or 2.5 mg (for 10.0 and 5.0 mg doses, resp.) if P-gp inhibitor is also a strong CYP3A4 inhibitor; avoid if already taking 2.5-mg dose
Reduce dose to 30 mg once daily
Concomitant P-gp inducer
Avoid (e.g., rifampin)
Avoid if P-gp inducer is also a strong CYP3A4 inducer
Avoid if P-gp inducer is also a strong CYP3A4 inducer
Avoid concomitant use with rifampin
Should be taken with food. Risk of stroke and bleeding increases with age but risk/benefit is favorable. CrCl, creatinine clearance; CYP3A4, cytochrome P450 3A4 enzyme; DOAC, direct-acting oral anticoagulant; NR, not reported; P-gp, P-glycoprotein; VTE, venous thromboembolism.